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Back Blood, Heart and Circulation Lymphedema Lower Extremity Lymphedema

Lower Extremity Lymphedema

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Podcast iconListen to the Cancer.Net Podcast: Leg Swelling After Cancer Treatment, adapted from this content.

Lymphedema is commonly thought of as swelling of the arm that can occur after breast cancer treatment. However, this condition can affect both men and women who are treated for other types of cancer, as well. Besides the arm, lymphedema most often involves the lower extremity — the leg.

Lymphedema is swelling, caused by the buildup of lymph in the tissues. Lymph is the fluid that carries immune cells (mostly lymphocytes) throughout the body. It is similar to a "highway" for your immune system. Tiny, bean-shaped organs called lymph nodes make lymph and filter bacteria and other harmful substances. They can be compared to "rest stops" for your immune cells. When the lymph nodes are removed, there is a backup of lymph into the surrounding tissues. Lymphedema can be very uncomfortable and sometimes painful. It can also delay the healing of wounds and raise the risk of infection near the swelling.

Causes and risk factors

Common causes of leg lymphedema include the following:

  • Surgery to remove lymph nodes in the groin, especially for cancers in the pelvic area (lower abdomen)—such as prostate, testicular, cervical, ovarian, uterine, and vulvar cancers—and for tumors of the leg, such as melanoma
  • Radiation therapy to lymph nodes in the groin
  • Cancer that has spread to the lymph nodes or a tumor in the abdomen that blocks lymph drainage

Lymphedema can develop days or weeks after cancer treatment. Often, it occurs months or years later. Sometimes, lymphedema is not related to cancer or its treatment. For instance, infection or injury to the lymph nodes may cause this problem.

Risk factors for lymphedema include having many lymph nodes removed or damaged during cancer treatment, being overweight or inactive, and having a past leg infection or injury.

Symptoms

Lymphedema can affect one or both legs. Symptoms include the following:

  • A sense of fullness or heaviness of your leg, or actual swelling
  • A feeling that your pants, socks, or shoes are too tight
  • Discomfort or pain in the leg
  • Skin redness and warmth on your leg
  • Stiffness, tightness, or hardening of your leg skin
  • Weakness or decreased flexibility of your leg or ankle

Lymphedema that occurs soon after cancer treatment usually is mild and may go away within weeks. Chronic (long-term) lymphedema is more common and may be severe. Talk with your doctor if you experience any of the symptoms listed above.

Treatment

The standard treatment for leg lymphedema is complete decongestive therapy (CDT). A physical therapist (a health care professional who works with patients to help restore mobility and physical functioning, while preventing further disability) or another person who is specially trained in treating lymphedema should perform CDT. Ask your doctor for a referral. CDT is also called complete (or complex) decongestive physical therapy, and it combines four treatments:

Skin care. You will receive instructions to keep your affected leg clean, moisturized, and free of infection because chronic lymphedema increases the risk for infection.

Manual lymph drainage. This technique involves gentle massage to help blocked lymph fluid drain properly into the bloodstream.

Compression. A lymphedema therapist will apply multiple layers of stretch bandages to your leg or fit you with a compression stocking or another garment for you to wear at home. Another treatment involves a pneumatic (air) compression pump. This pump has a cuff that wraps around the leg and applies pressure at intervals. However, a pump may make the swelling worse in some people. Your therapist will know if this is a good option for you. Use a compression pump only under a trained therapist's supervision.

Exercise. Your therapist will show you specific exercises to help regain and extend the range of motion and strength in your leg. You may need to wear your compression garment during exercise.

Additional treatments for leg lymphedema may include medications to treat related problems, such as antibiotics to treat infections or drugs to relieve pain. Surgery is only used to treat severe lymphedema after other treatments have failed.

Some studies show that lymphedema may improve with certain dietary supplements. However, supplements may cause side effects and can interfere with other medications. Talk to your health care provider before taking a supplement.

Prevention and managing lymphedema

Besides therapy, follow the self-care tips listed below to prevent lymphedema from getting worse.

Exercise. Exercise helps lymph drainage. However, in some people, strenuous exercise leads to lymphedema, so choose moderate exercises, such as walking. Talk with your doctor about when you can start exercising, which exercises are right for you, and whether you should wear a compression stocking during exercise.

Maintain a healthy weight. If you are overweight, losing weight can lower your risk of lymphedema. Learn more about weight control.

Raise your leg. When your leg hurts, elevate it on pillows.

Protect your skin. Apply moisturizer each day to prevent chapped skin. Avoid cuts, burns, needle sticks, or other injury to the legs and feet. If you shave your legs, use an electric razor to reduce the chance of cutting the skin. Outside, wear sunscreen with a sun protection factor (SPF) of 15 or higher. If you do cut or burn your leg, wash it with soap and water and put an antibiotic cream on the injured area.

Avoid temperature extremes. Do not go in a hot tub or sauna. When bathing, use warm water, and test the temperature with an unaffected limb. Also, don't apply a heating pad or ice to your leg.

Change your position. Avoid standing or sitting for prolonged times. While sitting, do not cross your legs.

Wear proper footwear. Shoes and socks should not be tight. Wear closed shoes, not flip-flops or sandals, to better protect your feet.

Note changes to your leg. Call your doctor or nurse if you have symptoms of lymphedema. In addition, call if you have any signs of infection: a fever (temperature over 100ºF) or leg redness, swelling, pain, or heat.

More Information

Fluid in the Arms or Legs or Lymphedema - ASCO Curriculum

Additional Resources

LIVESTRONG: Lymphedema

National Cancer Institute: Lymphedema

The National Lymphedema Network

Last Updated: April 14, 2011